Impact of Antenatal Depression, Anxiety, and Stress on Fetal

产前抑郁、焦虑和压力对胎儿的影响

• 批准号: 8111193
• 负责人: ZACHARY N STOWE
• 金额: $ 49.34万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8111193
• 关键词: Accounting; Acute; Address; Adverse effects; Affect; Alcohols; Antidepressive Agents; Anxiety; Area Under Curve; Arteries; Attention; Behavior; Biological; Blinded; Blood flow; CRH gene; Caffeine; Clinical; Conceptions; Coupling; Data; Data Analyses; Development; Dimensions; Doppler Ultrasound; Environment; Equipment and supply inventories; Exposure to; Fetal Heart Rate; Fetal Movement; Fetus; Follow-Up Studies; Frequencies; Genes; Genetic Polymorphism; Goals; Hamilton Rating Scale for Depression; Heart Rate; Heart Septal Defects; Hydrocortisone; Individual; Investigation; Literature; Low Birth Weight Infant; Measures; Mediating; Mediator of activation protein; Mental Depression; Mental disorders; Metabolic; Metabolism; Movement; Neonatal; Neurosecretory Systems; Nicotine; Outcome; Perinatal; Perinatal Exposure; Pharmaceutical Preparations; Phenotype; Population; Pregnancy; Pregnant Women; Premature Birth; Premature Labor; Psychometrics; Reporting; Resistance; Rest; Safety; Salivary; Severities; Stimulus; Stress; Symptoms; Time; Tobacco; Toxic Environmental Substances; Translating; Umbilical Cord Blood; Umbilical cord structure; United States; Withdrawal; Woman; base; cohort; design; fetal; impression; indexing; infant outcome; maternal depression; maternal serum; maternal stress; neonate; novel; prospective; reproductive; response; trait

Project 1 will focus on the fetal and obstetrical consequences of maternal stress, depression, and anxiety during pregnancy. Information that better informs the clinical decision potentially affects >400,000 women in the United States annually. The treatment of maternal depression and anxiety during pregnancy continues to stimulate vigorous debate with the emphasis on the reproductive safety of antidepressant medications. Recently, there have been reports of purported "antidepressant neonatal withdrawal", and a renewed attention with respect to potential teratogenic effects (e.g. ventral septal defects). Unfortunately, the potential impact of maternal stress, depression, and anxiety on the fetus and obstetrical outcome is seldom included in these reports. The extant literature on the impact of maternal mental illness typically uses single point assessments (predominantly in mid to late pregnancy) of maternal depression and anxiety. While such studies have demonstrated alterations in fetal activity, fetal heart rate, and an increase in obstetrical complications (low birth weight, preterm labor, preterm delivery), they have only speculated about the mechanisms based on cross sectional assessment. Similarly, these investigations have failed to account for other exposures that may influence outcome (medications, tobacco, etc). Project 1 will fill these gaps utilizing the well characterized women from Core B. We will determine the impact of maternal depression and anxiety, in any, on biological indices of stress (both acute and cumulative) and the relationship of these measures and maternal symptoms with uterine blood flow, fetal activity, fetal heart rate, obstetrical outcome, neonatal outcome. The center design permits blinded assessments of these relationships - an incremental advance over previous investigations. The focus on a clinical population will provide a cohort of pregnant women with antidepressant exposure. The modulatory effects, if any, of antidepressants on our outcome variables are unknown. Blinded assessment of obstetrical and neonatal outcome will directly address many of the concerns recently reported. The potential impact of exposure (e.g. ng/ml in cord blood) will be included in data analysis. The novel data generated from Project 1 will serve as candidate phenotypes for Project 2, and additional potential moderators of infant outcome in Project 3.

项目1将重点关注孕产妇压力，抑郁和焦虑的胎儿和产科后果 怀孕期间。更好地告知临床决策的信息可能会影响> 40万名女性 每年美国。怀孕期间母亲抑郁和焦虑的治疗继续 刺激有力的争论，重点是抗抑郁药的生殖安全性。 最近，有报道称“抗抑郁药新生儿戒断”，并更新了 注意潜在的致致造作用（例如腹膜缺损）。不幸的是， 孕产妇压力，抑郁和焦虑对胎儿和产科结果的潜在影响很少 包括这些报告。关于孕产妇疾病影响的现有文献通常使用单一 孕产妇抑郁和焦虑的点评估（主要在怀孕中期至晚期）。而这样 研究表明，胎儿活性，胎儿心率和产科的增加发生了变化 并发症（低出生体重，早产，早产），他们只猜测 基于横截面评估的机制。同样，这些调查未能说明 可能影响预后的其他暴露（药物，烟草等）。 项目1将利用Core B的特征性女性来填补这些空白。我们将确定 孕产妇抑郁和焦虑的影响，在任何情况下，对压力的生物学指标（急性和 累积）以及这些措施和母体症状与子宫血流，胎儿的关系 活性，胎儿心率，产科结局，新生儿结局。中心设计允许盲目 对这些关系的评估 - 比以前的研究的增量进步。专注于 临床人群将为一群孕妇提供抗抑郁药暴露。调节 抗抑郁药对我们的结果变量的影响（如果有的话）尚不清楚。盲目评估产科评估 新生儿结果将直接解决最近报道的许多问题。潜在的影响 数据分析中将包括暴露（例如脐带血中的Ng/mL）。 从项目1产生的新数据将作为项目2的候选表型，以及其他 项目3中婴儿结果的潜在主持人。